What is percutaneous laser discus decompression (PLDD)?

Percutaneous laser disc decompression (PLDD) is a minimally invasive therapy used to treat certain herniated discs. In this case, minimally invasive means that the procedure is characterized by a simple puncture and takes place under local anesthesia, which means the patient - in contrast to an 'open' back surgery - avoids a general anesthesia. Hospitalization and rehabilitation time decrease significantly. The PLDD is a particularly low-risk method, since the spinal canal does not have to be opened and the surrounding tissue is not damaged or removed. The decompression of the disc by laser is a decades-long (first time 1987) proven method that has been constantly evolving.

What is this procedure about? The aim of this treatment is the shrinkage of the protrusion of the disc and relief of the neural structures. Even if only a small proportion of the bulging disc parts are reduced by the laser, pain and neurological deficits will be alleviated or eliminated thanks to the volume reduction. Important to know: The treatment depends on the diagnosis, which means: The PLDD cannot always be used.

When is percutaneous laser disc decompression (PLDD) an option for me?

In most cases, back problems can be handled with conservative therapies such as injections, massage or medication. However, if they are not enough, the cause must be permanently remedied.

The method of percutaneous laser discus decompression (PLDD) achieves very good results, especially in case of strong small disc protrusions and moderate herniated discs of the cervical and lumbar spine. It is a gentle minimally invasive procedure, which is excellently able to eliminate the symptoms or significantly reduce them. Often, the method is useful in patients with spinal changes where there are no indications for microsurgery and in those patients with heart disease where major surgery or general anesthesia is not operable.

Operation procedure - with laser energy we shrink the protruded part of the disc

The laser intervention takes about 30-40 minutes. Unlike surgery, laser therapy does not require a skin incision. It is done percutaneously, which means by puncturing the skin under local anesthesia. We perform the entire procedure under X-ray or CT. We introduce a special needle into the disc protrusion. This is not just any needle, but an approximately 1-millimeter thick hollow needle, also called puncture cannula. When the tip of the cannula is correctly placed in the appropriate position, the next step begins. We push through the hollow needle an even thinner laser fiber - which allows us to bring certain, controlled laser energy as heat to the center of the protrusion. With the help of the laser energy we can reduce the volume of the protrusion and the pressure in the disc. Another effect of laser is to turn off the pain receptors inside the affected disc. The tissue evaporation of the protrusion leads to a reduction in volume and pressure and to the relief of the neural structures. In case of disc protrusions of the cervical spine, the procedure is performed under general anesthesia.  An 80% success rate makes the effect of this method clear.

Right after the treatment

On the day of PLDD, patients must maintain an adequate bed position to relax the treated disc. They will get light pain therapy and physiotherapy.

Post-operative days

Patients are mobilized the very next day after surgery. You will receive a detailed program with explanations of when and how long walking, lying, sitting, etc. are allowed or necessary. The lumbar spine or cervical collar should be worn for two to three weeks, within which bending, twisting and lifting are not allowed. Physiotherapy needs to be carried out for two to three weeks. Depending on the profession, the patient will not be able to work for two to six weeks. Driving and sports are allowed again after 6-8 weeks.

Benefits of percutaneous laser disc decompression (PLDD)

Not only because of the shortness of the procedure and its "elegance", are herniated discs being treated more and more often with this laser therapy. Benefits include rarely adhesions, muscles and joints remain intact, and nerves are not injured. Minimally invasive percutaneous access (1 millimeter) is possible. In addition, this therapy can be repeated and is particularly suitable for patients for whom general anesthesia poses a certain risk. Least but not last: Percutaneous laser disc decompression (PLDD) can be performed on multiple segments of the spine.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

If you decide to undertake your therapy and/or surgery in Berlin, we would want to make your stay as pleasant as possible. In our clinic, you are at the center of our attention! You can expect state-of-the-art equipment in all areas - from the operating room to the patient bedroom.

The latest, gentle, minimally invasive treatment procedures are the focus of our clinic. Together we try to find a suitable treatment for your complaints. The actual therapy takes place only after a detailed discussion with the patient, examinations and the diagnostics.

For us, as important as medical care, it is the commitment we take to guarantee our patients a high level of personal care that can, in turn, ensure them a comfortable stay.

During the period of inpatient stay our team of nurses will take care of you 24 hours a day. They also offer services in several foreign languages, including English, Russian, Polish, Turkish, Spanish, Italian, Arabic, Bulgarian and French. We care not only about your safety but also your needs, respecting traditions and religions.

Our team is made up of a group of highly qualified specialists who work together to guarantee you a quick recovery.